Provider Demographics
NPI:1053404657
Name:SUMMIT INTERNAL MEDICINE
Entity type:Organization
Organization Name:SUMMIT INTERNAL MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LAWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-267-1026
Mailing Address - Street 1:3025 SHRINE RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4744
Mailing Address - Country:US
Mailing Address - Phone:912-267-1026
Mailing Address - Fax:912-265-5415
Practice Address - Street 1:3025 SHRINE RD
Practice Address - Street 2:SUITE 290
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4744
Practice Address - Country:US
Practice Address - Phone:912-267-1026
Practice Address - Fax:912-265-5415
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT INTERNAL MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-02
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACI8306OtherRR MEDICARE
GAGRP3329Medicare ID - Type UnspecifiedMEDICARE GROUP #